As already mentioned, over half of patients with COPD are not able to use their devices correctly and this suboptimal use makes the medication less effective. Seven steps to optimise inhaler technique are shown in Figure 2 over the page. 

A systematic review showed that the most frequent pMDI errors (made by over 40 per cent of patients) were in:

• Co-ordination
• Not doing a full expiration before inhalation
• Speed and/or depth of inspiration
• No post-inhalation breath-hold.

Incorrect preparation was also frequently observed (29 per cent). Watching a patient demonstrate how they use their inhaler face-to-face remains the preferred method of assessment where possible, but remote consultations have increased markedly during the pandemic. 

Telephone consultations are already familiar to most clinicians and patients, and can provide an opportunity to reinforce the importance of optimal inhaler technique and allow healthcare professional and patient to talk through technique to identify areas/steps that require improvement. 

A video-enabled consultation can be helpful in improving technique with devices patients

are already familiar with or establishing that a change is necessary. Both video and telephone consultations can be used to identify patients who should be prioritised for face-to-face appointments. 

After every consultation, but particularly those completed remotely, a healthcare professional should recommend that the patient looks at online resources such as the patient inhaler videos hosted on the Asthma UK or RightBreathe websites. RightBreathe has the facility to send content directly to a patient’s email account from its app or website by simply pressing the share information button next to the relevant treatment. 

Sometimes, it may be possible to talk through the treatment on the telephone while the patient looks at the relevant RightBreathe page to help reinforce understanding and ask if they have any questions. For patients on inhaled corticosteroids in COPD, it will be possible to show ICS potencies and dosage information in case they have any concerns.  

Figure 2: Seven steps to correctly using an inhaler device

1. Prepare the inhaler device
2. Prepare or load the dose
3. Breathe out, fully and gently, but not into the inhaler
4. Place inhaler mouthpiece in the mouth and seal the lips around the mouthpiece
5. Breathe in:
   • pMDI: slow and steady
   • DPI: quick and deep
6. Remove inhaler from the mouth and hold the breath for up to 10 seconds
7. Wait for a few seconds then repeat as necessary